The use of simulator training offers new avenues for high-quality education in endoscopy. Nevertheless, even with the availability of various simulators, their validation and impact on training remain marginalized. Therefore, we evaluated the novel "Endonix" simulator, a 3D-printed simulator comprising an endoscope handle connected to a computer that does not require cumbersome technical setup (“plug-and-play”), allowing easy training access. The aim of this study was to prospectively evaluate the simulator's validity, feasibility and usability in novices, beginners and experienced endoscopists as well as to assess participants' perception of the simulator and simulation training in general.

Delegates at two international conferences (DGVS and ENDOCLUBNORD, both 2024 in Germany) were invited to participate in this study. Study participants were asked to complete a pre-testing questionnaire requesting their perception of endoscopy simulation training. Afterwards, two exercises were performed, covering line markings and ESD markings in a virtual environment. Following the simulation, participants were asked to complete the System usability scale (SUS) and NASA Task Load Index as well as a questionnaire evaluating the simulator.

A total of 310 participants completed the study (n = 146 DGVS, n = 164 EndoClub), comprising 114 novices, 49 beginners, and 147 experts. The majority reported no access to simulation training at their institution (83.9%), and only a minority had structured curricula available (21%). The majority of participants supported endoscopy simulation training (83.1%) and the requirement of simulation training before first patient encounters (61.9%). The majority of all three groups (novices: 74.4%, beginners: 62.2%, and experts: 63.1%) supported the introduction of the simulator at their institution, revealing rather good face validity. However, while the majority of novices (57.3%) found the simulator realistic, compared to a minority of beginners (34.9%) and experts (37.2%), revealing merely sufficient content validity. In contrast, construct validity was also favorable as experienced endoscopists completed both modules faster than novices or beginners. Criterion validity was assessed using the correlation of training time and experience level, which showed significant correlation for both exercises. The SUS yielded 75 out of 100 points (corresponding to good usability) with no discernible difference between novices, beginners and experienced endoscopists. The NASA-TLX, ranging from 0 to 600 points, reflecting level of exhaustion, exhibited a higher score in novices and beginners than experienced endoscopists (285 vs. 210 vs. 225 points, respectively, P<0.001).

The first validation of a novel virtual simulator demonstrated its feasibility and usability, with mostly sufficient validity. Many participants favored its implementation in endoscopy training, particularly for novice and beginner endoscopists, who were identified as the most suitable target learners. The availability of simulation training is currently not meeting the needs of trainees and trainers, demonstrating potential for inclusion in endoscopy training.